David Jerome Grachek Jr., D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

14866 Issued in MI

Practice address

13745 Northline Rd
Southgate, MI 48195-1866

Phone

(734) 284-9873

Fax

(734) 284-4161

NPI assigned

Dec 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• David Grachek, Jr.,DDS

  • General Practice Dentistry
  • Southgate, MI
  • NPI 1891325239
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265591531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13745 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951866",
            "telephone_number": "734-284-9873",
            "fax_number": "734-284-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13745 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951866",
            "telephone_number": "734-284-9873",
            "fax_number": "734-284-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRACHEK JR.",
        "first_name": "DAVID",
        "middle_name": "JEROME",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "14866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandi Gordon, BCBA
• Latrice Goree
• Lisa Goss, LLPC
• Kempaiah A Gowda, MD
• Stephanie Grabowski
• Kasha Annette Graves
• Jeanne Marie Gray, CNP
• Great Lakes Drugs LLC
• Greater Michigan Counseling Center PLLC
• Stephen Anthony Greco, LLMSW, QIDP, QMHP

• Dentist in Southgate, MI
• Providers in Southgate, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.